Learning Experiences

Inpatient Clinical Nutrition

The Clinical Nutrition Core (CNC) comprises intern learning experiences in the adult inpatient clinical areas. Interns develop competency in nutrition assessment, planning, intervention and evaluation for adults and elders with a variety of medical and nutritional diagnoses. Interns can expect to manage patients requiring standard and complex feeding regimens, including oral, enteral and parenteral nutrition support. Interns will provide MNT counseling and education for patients with a variety of health conditions, with a range of medical acuity. Emphasis is placed on evidence-based practice and critical thinking. Interns gain experience communicating and collaborating with the health care team, patients and preceptors.

After approximately three months of experience in the adult inpatient area, interns advance to clinical nutrition in adult critical care and pediatric acute care. The critical care service focuses on expanding interns’ knowledge of and experience managing complex enteral and parenteral nutrition support regimens for patients with multiple and complex medical conditions in the Intensive Care Unit. The goal of the Pediatric Acute Care rotation is for interns to gain experience performing nutritional assessment and providing care for pediatric patients, ranging in age from 0-18 years, with a variety of medical and nutritional diagnoses.

Ambulatory Nutrition

Interns enter Ambulatory Nutrition with experience managing standard oral, enteral and parenteral nutrition regimens, medical record documentation, laboratory interpretation, and MNT counseling. The Ambulatory Nutrition experience focuses on expanding interns’ knowledge of and experience with nutrition counseling and education in ambulatory settings. Learning experiences take place at UC Davis ambulatory care clinics in the Greater Sacramento Area.

Intern learning experiences are scheduled in adult or pediatric ambulatory care clinics. Interns provide one-to-one MNT counseling and education for clients with a variety of health conditions, ranging in age from infants to elders. In addition, interns may gain experience in a group education settings depending on the assigned clinic rotation. Ambulatory rotation requires interns to translate nutrition practice standards and guidelines into practical advice for clients, adjusting the content of sessions based on clients’ level of education, readiness to change, and cultural/ethnic practices. Nutrition interventions may include health promotion, health maintenance, management of acute medical conditions, and lifestyle modification for management of chronic diseases. Interns monitor interventions and make changes to recommendations where appropriate. Emphasis is placed on evidence-based practice and critical thinking. Interns communicate and collaborate with the client and the health care team. Interns attend team meetings to discuss nutrition care plans and refer to appropriate team members or community resources when a need is identified.

Community Nutrition

The Community Nutrition experience focuses on expanding interns’ knowledge of and experience with nutrition counseling and education of in a variety of community settings, which may include WIC, the Sacramento Food Bank and Family Services, and Meals on Wheels. Interns gain knowledge of the program’s target population and nutrition services provided, as well as the agency’s organizational structure, funding methods/resources, and methods of program evaluation. Interns learn and apply federal rules and regulations, as applicable. Interns participate in the daily operations of the agency, and gain experience conducting projects, such as developing education materials and lesson plans.

Management

The management rotation takes place at UC Davis Medical Center in our conventional, self-operated Food and Nutrition Services (FNS) Department. Patient foodservice is responsible for providing 900 to 1200 patient meals per day through a conventional trayline model.  Meals provided meet general nutrition guidelines based on federal government recommendations for healthy individuals and are modified to meet the requirements for specific diagnoses and vary in consistency based on patient needs and age.  Our department operates retail food services at three satellite cafes: Scrubs Café at the Medical Education Building, Lawrence Ellison Ambulatory Care Center Café, and the MIND Institute Eatery. FNS serves over 3 million meals to patients, staff, and visitors each year. 

The management rotation comprises intern learning experiences in production, storeroom, cafeteria, and patient food service. The goal of this rotation is to provide interns with experience in institutional food service management, retail food service management, and clinical nutrition management. Experiences include managing, training, and coordinating activities of food production, food sales, and retail services.  Retail operations include managing participation in cafeteria staffing plans and meal service, and developing and marketing special occasion meals. Interns participate in daily operational activities of the patient food services including meal preparation and service, diet kitchen, cold and hot-prep areas, storeroom, and retail areas. Interns participate in personnel activities, which may include staff training and competency assessment, scheduling, interviewing, employee performance (communication and corrective action), and annual employee evaluations. Interns also provide in-services and education to personnel on an as-needed basis. Interns gain exposure to union contracts and labor relation issues. Interns are expected to problem-solve and offer solutions for unexpected situations (e.g. staff injury, power problem, food quality issues, mechanical malfunction).  Completion and documentation of safety and sanitation inspections according to state policy and procedure is also a learning experience in this rotation.  Interns participate in routine quality assurance and continuous quality improvement practices. 

Interns work with management staff and peers to plan and oversee a one day theme meal for customers in the retail area. Interns determine menu theme, develop recipes, procure food items, market the theme meal, calculate food costs, prepare recipes, serve food, and calculate revenue.

Elective

Elective experiences provide opportunities for interns to gain further depth and breadth in an area(s) of personal interest through additional supervised practice hours. Experiences may include:

The availability of elective rotations varies annually, as each site has specific scheduling constraints and can accommodate a limited number of interns. The primary learning objective is for interns to demonstrate an understanding of the various sites where nutrition care can be provided in the continuum of care, as well as understanding the benefit and cost to the client and health care system for providing service at a particular site. Interns shall identify specific learning objectives and activities with the preceptor prior to the start of the elective rotation.

Staff Relief Experience

After demonstration of competence, interns complete staff relief experience in inpatient clinical nutrition. Staff relief experiences solidify interns’ knowledge, provide an opportunity to function independently and reinforce expected practices for an entry-level dietitian. Interns demonstrate the depth and range of clinical nutrition skills learned in the internship.  Interns apply assessment, care planning, implementation, problem-solving and documentation skills. Interns are supervised by a dietitian, who reviews and co-signs all nutrition documentation in the electronic medical record.

A minimum of 10 days of supervised staff experience in inpatient clinical nutrition at a competent level is required for internship program completion. Most often, interns have the opportunity to complete two to six weeks of staff relief experience in the inpatient clinical area, depending on the internship and department schedule and the intern’s interests.

Case Study

The purpose of the case study assignment is to develop an in-depth understanding of the relationship between the disease process and nutritional care of a patient.  Interns demonstrate their knowledge and competence through both a formal written report and a professional oral presentation. The case study assignment is a summary of the nutritional care provided to a patient on one of the inpatient clinical services or ambulatory clinics.  The emphasis of the case study is on nutritional care.  Points of the medical care are presented, as they are pertinent to the nutrition care provided by the dietetic intern.  The case study builds interns’ skills in professional writing, verbal communication, critical evaluation of the literature, and applying the nutrition care process.

Journal Club

The primary goal of the journal club assignment is to enhance the dietetic intern’s ability to critically evaluate and effectively present research to professional colleagues (dietetic interns, registered dietitians).   Interns critically evaluate the literature, including interpreting study designs and methods, addressing the strengths and limitations of studies, evaluating results and conclusion of the studies in relation to the hypothesis, and sufficiently discussing applications in practice. Interns develop a presentation background and study summary tailored to the target audience, demonstrating professional writing and verbal communication skills. Interns facilitate a journal club discussion with attendees.

Other Intern Classes

In addition to didactics that are scheduled in alignment with each rotation, interns can also expect to enhance knowledge through other didactics, including professional development, media and technology, and legislation and public policy.